We’veÂ finally stepped off the curb and are moving full speed ahead with our CPOE implementation. As a result I spent quite a bit of time last week with our Siemens assigned CPOE consultant. Heâ€™s a pharmacist which makes things nice because we understand each other and speak the same language.
The goal of one of the meetings I attended last week was to discuss the resources necessary to implement a CPOE system. Needless to say the project is going to be resource heavy. When it came time to tease out the IT pharmacist part of the project I was a little surprised at what I heard. The time requirements werenâ€™t surprising – several hundred hours – but where the pharmacist fits into the entire scheme was.
Are you ready? Wait for itâ€¦wait for itâ€¦ The pharmacistâ€™s job is to manually build the CPOE drug formulary using a spreadsheet. After all the preaching Iâ€™ve done in regards to what an informatics pharmacist should and should not be doing, it was all I could do not to laugh out loud when the Siemens consultant laid out the work plan for the CPOE project.
You see, the pharmacy drug master, a.k.a. formulary, drug dictionary, etc. is manually dropped into a Microsoft Excel spreadsheet and the pharmacist is supposed to spend several hundred hours making it â€œeasier for the doctors to read” and adding several fields that donâ€™t already exist in the pharmacy system. It seems that the Siemens Pharmacy System and Siemens CPOE System aren’t well integrated. While we can interface the drug dictionaries following the initial upload we cannot simply use the pharmacy drug dictionary for the CPOE system.
I canâ€™t tell you the number of times that the pharmacist looked at me during a work session and said â€œwhen youâ€™re working the spreadsheetâ€¦â€. Stop laughing, itâ€™s not funny. Ok, it is kind of funny, but stop laughing anyway.
Itâ€™s going to be difficult for informatics pharmacists to broaden their scope as long as vendors see them as little more than tools for data entry. Then again maybe I’m the one who has it all wrong. Iâ€™m just sayinâ€™.
My thoughts on pharmacy informatics can be found in several places on this site.
- Where is pharmacy informatics headed (July 1, 2009) – “Many IT pharmacists are involved in much more mundane tasks such as maintaining pharmacy formularies or creating and maintaining billing reports. Calls to investigate â€œprinter problemsâ€ or reset forgotten passwords are not uncommon. Many of these issues certainly do not require the knowledge base of an IT pharmacist and often times pull them away from other important tasks.”
- View on technology-enabled practice from ASHP (August 27, 2009) – In reference to an article1 in AJHP â€œTurning these ideas into reality will be challenging. As a group, pharmacy has been unable to make significant changes to their practice setting for more than 30 years. I have no idea why, but it is a serious problem. Without forceful leadership pharmacy will be using the same practice model for another 30 years and nobody wants that.â€
- Use of pharmacy informatics resources in hospital pharmacist (November 17, 2009) – In reference to an article2 in AJHP that took a look at the use of pharmacy informatics in approximately 200 hospitals across the US. â€œAny facility serious about taking advantage of pharmacy technology, informatics and automation has no choice but to consider the services of a pharmacy informatics specialist.â€ I still believe that, although what role they will play remains uncertain.
- Requirements for a pharmacy informatics professional (December 14, 2009) – â€œI can teach anyone how to maintain a system. What I canâ€™t do is teach someone logic and how to be intelligent and forward thinking. In my humble opinion, [employers are] looking at [hiring practices] all wrong. Focus on the key components and forget about the system requirements. If you happen to get it, great; donâ€™t go looking for it.â€
- Confusion and varying opinions regarding the role of pharmacy in informatics remains the norm (July 20, 2010) – Â â€œPharmacy informaticists should be intricately involved in making sure that systems are designed to include pharmacy workflow, that reports being written provide the necessary information to be clinically relevant, that current clinical standards are adhered to during implementation of new systems, be the representative at the table during discussions of integration and interoperability of hospital systems, provide insight into new systems that can help pharmacists enjoy more freedom from the pharmacy and so on. What they shouldnâ€™t be is the guy sitting in a room plugging away at a spreadsheet all day or fixing the fax machine when it breaks.â€ Now you know why I almost laughed out loud.
- Technology-enabled practice: A vision statement by the ASHP Section of Pharmacy Informatics and TechnologyÂ Am J Health Syst Pharm 2009; 66: 1573-1577
- Use of pharmacy informatics resources by clinical pharmacy services in acute care Am J Health Syst Pharm 2009; 66: 1934-1938
10 thoughts on “Quick Hit â€“ CPOE, a pharmacistâ€™s time and laughter”
Jay, you’re clearly a technologist that walked the wrong path early on. Your true talent is clearly being wasted at your present job. You need to go to work for Talyst, or another forward thinking medical technology company. You have the skill, the desire, God knows you have the brain. Too bad they haven’t snapped you up yet, clearly their loss, because I don’t think they understand how much you have in that rather large cranium of yours. ;-)
Hey, I also think the fact you have IT in your title is what gets you stuck doing stuff like this. IT work is the worst.
@Rob, he thinks he’s too cool for Talyst
Hello @carla and @rob, I’m still in the room. I can hear you.
Do you get a new email address every week @carla?
I think he’d be a great addition to your organization. He has a big brain, and it’s full of GREAT ideas. I still believe he’s in the wrong business. He’s a technology guy at heart and he needs to either go to work for a technology company or venture out on his own.
As for thinking he’s too cool? That’s just not in his DNA. If you truly wanted him I’m sure he’d listen to a reasonable offer. He’d make a great Evangelist, he’s basically already doing that for you, just not full time.
Then again… hiring him might be a bad idea. Your developers would hate their new workload.
My facility is switching to Siemens, and I was just told this tonight (that we were going to have to hand code the formulary). I’m not technically an IT pharmacist, but the pharmacist with the most IT experience (pre-pharmacy I did some programming/database design), so they often ask me about IT issued. I was like, “No way is that true.” Your blog post was the first thing that popped up in my search.
Now I’m disheartened. I guess YES WAY.
Yep, it’s a very manual process. Gotta’ love technology….and Siemens.
My facility is in the process of implementing Siemens CPOE and I have been aiding in the spreadsheet. I wanted to ask, how did the implementation go at your site? On the pharmacy side, what would you say is an appropriate number of staff needed to dedicate to the project?
Thank you for any advice!
Implementation was still a few months away when I left the hospital. I understand that they’re still running their pilot. In other words the implementation is going poorly. The spreadsheet work is mind numbing, but important. The better you build the sets and meds for the physicians, the smoother the transition will be. Don’t take my word for it, ask around. Others will tell you the same thing.
You need at least one FTE from pharmacy dedicated to the CPOE project. Any less is just begging for failure. The workload is tremendous, and keeping your mind on task is important. Trying to do other things along with CPOE will ultimately cause frustration and delays.